peds GI Flashcards
The three
examination signs that best suggest dehydration in children are
an abnormal respiratory pattern, abnormal skin turgor, and prolonged
capillary refill time, although parental report of the child’s history
is also helpful in the assessment.
Red Flags in a Child with Diarrhea
Warranting Urgent Physician Evaluation
Caregiver report of decreased tearing, sunken eyes,
decreased urine output, or dry mucous membranes
fever
Frequent and substantial episodes of diarrhea
Mental status changes (e.g., apathy, lethargy, irritability)
Persistent vomiting
Poor response to oral rehydration therapy or inability of the
caregiver to give adequate therapy
Visible blood in the stool
Young age (younger than six months) or low body weight
(less than 17 lb, 10 oz [8 kg])
Rehydration for mild to moderate dehydration
Give 40-50 ml/kg over first 4 hours
This can be accomplished at home by competent caregivers
using a syringe to administer approximately 1 mL of oral rehydration solution
per kg of body weight every five minutes over three to four
hours.
Timing of pain preceding nausea and vomiting and absence of diarrhea in most cases are distinguishing factors from gastroenteritis.
appendicitis
Daily Maintenance Fluid Requirements
Calculate child’s weight in kg
Allow 100 ml/kg for first 10 kg body weight
Allow 50 ml/kg for second 10 kg body weight
Allow 20 ml/kg for remaining body weight
Example #1 of Daily Fluid Calculation
Child weighs 32 kg
100 x 10 for first 10 kg of body weight = 1000 ml
50 x 10 for second 10 kg of body weight = 500 ml
20 x 12 for remaining body weight = 240 ml
1000 + 500 + 240 = 1740 ml/24 hr
Example #2 of Daily Fluid Calculation
Child weighs 8.5 kg
100 x 8.5 for first 10 kg of body weight = 850 ml
No further calculations
850 ml/24 hr
Example #3 of Daily Fluid Calculation
Child weighs 14 kg
100 x 10 for first 10 kg of body weight = 1000 ml
50 x 4 for second 10 kg of body weight = 200 ml
No further calculations
Constipation in Newborn Period
First meconium should be passed within 24-36 hours of life; if not, assess for:
Hirschsprung disease, hypothyroidism
Meconium plug, meconium ileus (cystic fibrosis)
Constipation in Infancy
BF babies can typically have BM once a week; formula babies can have stool daily to every 3 days.
Increase in belly-time and or vertical time to have natural decompression. Can do rectal stimulation. Karo syrup is used less secondary to the sweetness of it (promoting child to drink sweet). Prune juice depending on age. Increase in fruits/fibers and can also use miralax
Encopresis
inappropriate passage of feces, often with soiling.
May result from stress
too backed up that the Large intestinal wall is too stretched. Like a stretched rubber band – it does not squeeze effectively anymore. Takes months to recover its function.
Vomiting
Differentiate bilious versus nonbilious
Bilious == ER, needs to get scanned -> volvulus, malrotation, intussesception, etc…
Therapeutic management
Zofran is the go to! Tigan, Phenergan—Too sedating
Reglan and the erythromycin antibiotic family promotes moving food forward. Not first choice
Nursing considerations
Reintroduction food/fluids-Watch reintroduction of dairy – curdles from the acid
Gastroesophageal Reflux (GER)
Caffeine, second-hand smoke, alcohol increase in GER symptoms
Diagnostics
H&P
Upper GI
Esophageal pH
Therapeutic management
Food avoidance, Thickened feeds, HOB
Famotidine or Prevacid most common
Nissen fundoplication
Hypertrophic Pyloric Stenosis (HPS)
Constriction of pyloric sphincter with obstruction of gastric outlet
First born males
‘olive pit’
3-7 weeks of age
Surgeon will request a metabolic panel to r/o Hypochloremic metabolic alkalosis that needs to be corrected prior to surgery
Appendicitis
S/S-o dull, steady epigastric or periumbilical pain; moves to RLQ pain, may wake child from sleep
Diagnostic evaluation-McBurney point
CBC,CRP
US, CT
Meckel Diverticulum
Typically a painless bloody stool. Gastric mucosa in the wrong place.
Complication
Volvulus—medical emergency
Intussusception-paroxysmal, colicky pain with currant jelly stools, a palpable RUQ mass
Hemorrhage
Obstruction
Diagnostic evaluation
Bloody stool/ Meckel scan
Therapeutic management-
Surgical resection
Peptic Ulcer Disease (PUD)
Gastric/Duodenal
Gastric-– pain in anticipation of eating (stomach makes acid when smelling the food)
Duodenal- pain after eating, when the acid is secreted out from the stomach
Etiology-Unknown- H.pylori
Pathophysiology
Diagnostic evaluation
History
Endoscopy
Therapeutic management:
Medications
Umbilical hernias –
– not urgent. No intestine gets stuck. Just fat.
Inguinal hernias
are high risk and need to get repaired. 4-6 hrs to try to save the intestine if it cannot be reduced (red-blue skin/swelling, leg stays abducted, pain with probable vomiting)
is characterized by unexplained irritability and intense crying in healthy infants, apparently associated with abdominal pain
3 weeks to 3 months. Peaks at 6-8 weeks. (+) fam hx in other sibs/parents.
Physiologically takes the gut 3 months to work efficiently as well as the child can roll over and decompress naturally.
During the attack, the infant appears hypertonic with entire body stiffened, hands clenched, and legs flexed rigidly over abdomen
Colic
History: Episodic, intense, persistent crying for periods up to 4-6 hours
Most often occurs in the late afternoon and evening
Legs drawn up to abdomen
Hands clenched
Feet may be cold
Child passes flatus
Colic
famotidine
1mg/kg/day divided in 2 doses
